Peripheral Neuropathy and Obstructive Sleep Apnea

I just saw a patient 5 weeks after major tongue and soft palate surgery for obstructive sleep apnea, and as expected more often than not, his sleep quality was significantly improved. He did not suffer from brain fog anymore, and was able to think clearly again, something he was not able to do for more than 30 years. He was very happy with the results. As he was leaving the exam room, he wanted to show me something. He took off his shoes, and then his socks, and asked me what I thought.

I was a bit confused by his request, but then I remembered that he showed me his feet many months prior to his procedures. Compared to his right foot at that time, his left foot was more dusky, red and scaly, and not too healthy looking. He had peripheral neuropathy with pain, burring and numbness, for which he was being treated by another doctor. On the post-operative visit, his left foot looked much healthier. He also noted proudly that although he still had some numbness, his burning and pain were completely gone.

Peripheral neuropathy is a common condition seen usually in diabetics, but can also occur in non-diabetics. I wasn’t surprised by his result, but it was a bit unexpected. It not something that’s routinely described as a potential benefit of treating obstructive sleep apnea. We know that sleep apnea causes a stress response that clamps down on blood vessels of the distant extremities. 

I did a quick literature search of the connection between obstructive sleep apnea and peripheral neuropathy and found a handful of studies. One report found that patients with obstructive sleep apnea without any symptoms in the feet had objective measures of diminished nerve function, which improved significantly after CPAP therapy. Another paper described resolution of peripheral neuropathy pain (but not numbness) in a non-diabetic after CPAP. 

Knowing that obstructive sleep apnea and diabetes frequently go hand in hand, and that diabetes and peripheral neuropathy also go together, there’s a good possibility that the first and the last can also be linked as well. The real question that needs to be asked is, how many people with peripheral neuropathy have obstructive sleep apnea, and if treated adequately, how many can be helped or even cured? Another question that follows is, should all diabetics be routinely screened for obstructive sleep apnea? Knowing that obese diabetics can have up to an 80% chance of having obstructive sleep apnea, perhaps the answer should be yes.

If you’ve been diagnosed with obstructive sleep apnea, did your foot pain or numbness get any better after using CPAP, dental appliances or surgery?


Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

23 thoughts on “Peripheral Neuropathy and Obstructive Sleep Apnea

  1. Had significant neuropathy in left upper thigh (Meralgia paresthetica). Proper control of COSA with CPAP device cleared the problem over a period of time.

  2. Yes, I saw a significant improvement. I hadn’t had my neuropathy diagnosed because it wasn’t the biggest problem in my life. After CPAP, the redness in my right foot subsided and I’ve only had minor pain flares in the winter since. My doctor didn’t seem to think they were connected, but it was blatantly obvious to me. Then again, he doesn’t seem to listen well anyway.

  3. There’s obstructive sleep apnea, diabetes and peripheral neuropathy, 3 maladies, 4 if you add in a distinction with polyneuropathy, that are correlated for numerous reasons, in my view. Diabetes can cause peripheral neuropathy. This is known. There is a correlation between obstructive sleep apnea and peripheral and polyneuropathy, but it is unclear which causes what.

    I have progressive peripheral (and maybe central) polyneuropathy, likely CMT2, affecting numerous parts of my body (eye, bowel, feet, legs and now the right hand), and have moderate to severe obstructive sleep apnea. After treatment for obstructive sleep apnea my polyneuropathy was unabated, continued to progress, no difference. It may be possible that the peripheral polyneuropathy causes the obstructive sleep apnea, rather than the other way around, or they might be in my case coincidental.

    Good questions, though and worthy of some research to sort out the entanglement of maladies and the causal relations.

  4. I have had peripheral neuropathy in my hands, presumed to be due to thoracic outlet syndrome. ulnar distribution, mostly on the left. the tingling symptoms got better with treatment of OSA.

  5. What is so surprising? Why the word link is used so much is likely to cover ones “buttocks”. Why do we not look at the anatomy physiology and biochemistry here, beginning with the anatomy as scientists do? It starts with airway and then the stress response and associated biochemistry (stress hormones, etc.) physiology and anatomy responses.
    Of course unobstructed airway, especially when the body can anatomically stable, most often is adequate to reduce the most immediate threat of death (no air) and reduce the body need to respond with the stress response with the outpouring of stress hormones into the system. And note that surgical solutions to this are not limited to sleep as is CPAP or oral appliances worn only during sleep.
    What about blog discussions on how the body works and what we know and do not know? I gather that we may learn allot about what we don’t know that we know because of blinders we wear or are encouraged to wear to navigate through our professional and/or personal life, blinders that, likely another does not have.

  6. No kidding. Shooting pains, aching, tingling, burning, twitching (BFS), incomplete eyelid closure, mixed dysrhythmia from EGG, CPPS, allodynia, dysgeusia, and morning/night weakness, among other things! Lots of positive autoimmune panels. I’m at the extreme end of the spectrum though, with an AHI of 50 undiagnosed for 10+ years. Vast resolution w/CPAP, though incomplete.

  7. It seems like my post on peripheral neuropathy hit a nerve. This is an area that not only needs more research, but also more visibility. Thanks for all your comments.

  8. I am so happy to read this! I was just diagnosed with moderate OSA, haven’t started CPAP yet. I have been seeking relief for what seems to be some kind of intercostal nerve neuropathy for almost 3 years….looking forward to seeing whether treating the OSA will end up helping the rib/side pain as well.

  9. Susan,

    Although treating OSA is not meant to alleviate pain, we know that improved sleep of any kind can be helpful for pain in general. Experimentally, poor sleep lowers your pain thresholds. Even if your pain doesn’t improve, hopefully, you’ll start to sleep better. It may take a while, so be patient. Good luck.

  10. Obstructive Sleep Apnea can result in Secondary Pulmonary Hypertension. But Pulmonary Hypertension could be the Primary disorder that can present with shortness of breath that would affect sleeping and therefor can be confused with Pulmonary hypertension caused by Obstructive Sleep Apnea.

  11. Hi, i googled cpap and peripheral neuropathy and found your link. i have had PN for last years on bottoms of feet at night for 6 years.. i am 67 years old with no diabetes. my family doctor and va doctor both told me they could not help me. i was told after sleep study i had apnea. i have been on cpap machine for one week now and my feet are better so i am glad to find someone on planet earth that is looking at the correlation between the two conditions.i searched the internet for years reading PN posts and found no relief. HAVE a good day,Howard

  12. I Believe I have had undiagnosed sleep apnea since childhood. I was diagnosed eight years ago and have struggled with the CPAP constantly. In eight years I’ve gone from zero medications to over 10 for a wide variety of health issues ranging from hypertension, neck and back pain, gout, fatigue, memory problems and most recently peripheral neuropathy. I do believe that the sleep apnea could be responsible for most if not all of these health issues. I don’t know why I didn’t make the connection between sleep apnea and my foot pain before. Thanks for renewed hope.

  13. I have polyneuropathy and obstructive sleep apnea. i am using the cpap machine for about 4 months. my main problem is keeping my balance plus some leg muscle weakness. sleep studies showed 49 apneic spells with os sat down to 83% and average of 87 % PO2. WITH THE CPAP MY APNEIC SPELLS DROPPED TO 4 per hour with my lowest po2 of 91% and my average at 93% my WALKING HAS IMPROVED SLIGHTLY but I am also slowly losing weight, I am 45 ibs over weight.
    Would adding o2 to my cpap mask to bring up my po2 to 97 or 98 % possibly improve my polyneuropathy or at least stop the progression faster or more effectively than just the CPAP machine? —so that I don’t end up in a wheel chair. If the axonal damage is caused by deprivation of o2, would the increased oxygenation help to prevent further damage and/or heal the damage already done?

  14. Yes, it got much better with use of the CPAP! I often have pain in my feet and my lower legs. The pain (and feeling of burning heat) used to occur pretty much all the time but the severity varied from excruciating to only somewhat bothersome. I sought relief from physicians but basically their reaction was it was from pre-diabetes (A1C range is 6.2 to 6.8) and it would never get better. However, about 15 years ago, I had a sleep test and was diagnosed with sleep apnea and started to use a CPAP. Since then, not only can my wife sleep in the same room with me, but my leg pain has pretty much disappeared. I would say I am pain-free 90% of the time but a somewhat bothersome pain returns about 10% of the time. (I am experiencing it now which explains why I am exploring the internet about it and ran across your website).

  15. I’m 63 years old. I have been on a cpap machine for years. About six months ago I started having headaches fog headaches tingling in my body naseau feeling of confusion sweats burning feet. It seemed it would start at 2:am every morning. I would feel tough until late in the day. Haven’t worked the whole time. My doctors have increased my medications significantly trying to cure the problem. I have been in mental health,neurology. Ocology and my primary doctor all working together no such luck. Could you help me?

  16. Mike,
    Same here about feeling terrible all morning and burning pain at night. I thought or at least had hope there was a connection between my apnea and my neuropathy but the Cpap does not seem to be helping. I’m at about 10 medications also and my quality of life has gone downhill fast since getting neuropathy. They say I have both short and long fiber peripheral neuropathy. Now my sight is blurry, I get frequent headaches and bad stomach problems. I had to quit a job I have enjoyed for over 30 years because I can’t stay on my feet or concentrate, stay focused anymore. I’m 60 and don’t have the energy to do the things I love to do. My sleep cycle is totally screwed up. If you find any answers please post. I will do likewise.

  17. Peripheral Neuropathy seems to be originating in my 2nd or 3rd vertebrae from my pelvis, the sensations are of muscular pain, tingling, burning and back pain. These symptoms were not present until I underwent CPAP therapy. Upon starting CPAP therapy I awoke in agony, my spine and legs shooting so hard that I being a grown man, screamed like I was being cut in half or impaled. These severe symptoms have reduced over time, but the peripheral Neuropathy is still very present and active 2 years after CPAP therapy. When I was tested for OSA I was stopping breathing 96 times an hour in my sleep, to top it all off I’ve had several developmental issues, being on the autism spectrum. I had spent my entire life trying to establish a sense of normality and control it’s side effects, but after CPAP my autism is in 𝕄𝕒𝕩𝕚𝕞𝕦𝕞 𝕆𝕧𝕖𝕣𝕕𝕣𝕚𝕧𝕖.

  18. Recently went back to using Cpap because of slightly high hematocrit test. Diagnosed with 33 episodes during the night. My issue is Cpap use appears to be causing my neuropathy levels to sky rocket, which is the opposite of most people’s reaction to Cpap use.

  19. Mike,

    Sorry to hear. Sometimes, CPAP makes things much worse. Your best bet is to talk with your sleep doctor about other proven options such as a mandibular advancement device, surgery or a tongue nerve pacemaker. Gook luck.

  20. I’ve recently switched from a Resmed CPAP machine to their ASV unit which locks into the humidity unit and used slightly larger airway tubing and the same full face mask. Having been on the CPAP for some years, unfortunately the reverse is true for me. My Peripheral Neuropathy is getting worse, rapidly. I’m struggling to cope with the ASV so don’t expect any improvement. Any help appreciated.